title: Perinatal air pollutant exposures and autism spectrum disorder in the children of Nurses' Health Study II participants.
abstract: OBJECTIVE
  Air pollution contains many toxicants known to affect neurological function and to have effects on the fetus in utero. Recent studies have reported associations between perinatal exposure to air pollutants and autism spectrum disorder (ASD) in children. We tested the hypothesis that perinatal exposure to air pollutants is associated with ASD, focusing on pollutants associated with ASD in prior studies.
  
  
  METHODS
  We estimated associations between U.S. Environmental Protection Agency-modeled levels of hazardous air pollutants at the time and place of birth and ASD in the children of participants in the Nurses' Health Study II (325 cases, 22,101 controls). Our analyses focused on pollutants associated with ASD in prior research. We accounted for possible confounding and ascertainment bias by adjusting for family-level socioeconomic status (maternal grandparents' education) and census tract-level socioeconomic measures (e.g., tract median income and percent college educated), as well as maternal age at birth and year of birth. We also examined possible differences in the relationship between ASD and pollutant exposures by child's sex.
  
  
  RESULTS
  Perinatal exposures to the highest versus lowest quintile of diesel, lead, manganese, mercury, methylene chloride, and an overall measure of metals were significantly associated with ASD, with odds ratios ranging from 1.5 (for overall metals measure) to 2.0 (for diesel and mercury). In addition, linear trends were positive and statistically significant for these exposures (p < .05 for each). For most pollutants, associations were stronger for boys (279 cases) than for girls (46 cases) and significantly different according to sex.
  
  
  CONCLUSIONS
  Perinatal exposure to air pollutants may increase risk for ASD. Additionally, future studies should consider sex-specific biological pathways connecting perinatal exposure to pollutants with ASD.
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA 02115, USA. aroberts@hsph.harvard.edu
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Roberts
authors.forename: Kristen
authors.initials: K
authors.lastname: Lyall
authors.forename: Jaime E
authors.initials: JE
authors.lastname: Hart
authors.forename: Francine
authors.initials: F
authors.lastname: Laden
authors.forename: Allan C
authors.initials: AC
authors.lastname: Just
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Bobb
authors.forename: Karestan C
authors.initials: KC
authors.lastname: Koenen
authors.forename: Alberto
authors.initials: A
authors.lastname: Ascherio
authors.forename: Marc G
authors.initials: MG
authors.lastname: Weisskopf
mesh_terms: D000293:Adolescent; D000393:Air Pollutants / Q000032:analysis / Q000633:toxicity*; D002648:Child; D002659:Child Development Disorders, Pervasive / Q000139:chemically induced* / Q000453:epidemiology*; D002675:Child, Preschool; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D008297:Male; D016017:Odds Ratio; D012307:Risk Factors; D012727:Sex Characteristics; D014481:United States / Q000453:epidemiology
chemical_list: D000393:Air Pollutants